Psoriasis is a chronic (long-term) inflammatory skin condition that can affect any part of the body, including the scalp. Scalp psoriasis can cause dryness, red patches, bleeding, and dandruff-like flakes. You may also experience hair loss.
Hair loss from psoriasis is usually temporary. In rare cases, you may develop alopecia areata, a condition that can lead to permanent hair loss and scarring.
If you are losing hair, you may notice that your hair is gradually thinning. Your hair may not look as full, and you may have thinning hair or bald spots.
You’re also likely to see other symptoms of scalp psoriasis, such as:
- Reddish spots
- Dry scalp
- bleeding
- A burning sensation of the scalp
- Itching
- Dandruff-like flakes
- Silver-white scales
Psoriasis causes inflammation that can damage the hair follicles on the scalp, which can lead to temporary hair loss.
Research shows that psoriasis of the scalp can affect interfollicular epithelium (the skin located between the openings of the hair follicles) and lead to perifollicular inflammation, which is inflammation of the tissue surrounding the hair follicles.
Scalp psoriasis inflammation can also lead to hair loss by shrinking the sebaceous glands (which produce and secrete an oily substance called sebum) and disrupting the hair growth cycle through increased shedding.
In rare cases, people with severe scalp psoriasis may experience scarring alopecia, which causes permanent hair loss. A person can develop alopecia areata from psoriasis due to persistent scratching, secondary infection, or failure to treat other psoriasis symptoms such as inflammation, which can cause irreversible damage to the scalp and hair growth cycle.
Seek medical help for scalp psoriasis if you experience hair loss or painful or uncomfortable symptoms. It’s also important to seek treatment if hair loss or other symptoms, such as flakes and flakes, are affecting your confidence or interfering with your ability to enjoy everyday life.
A dermatologist (a doctor who specializes in skin, hair and nail conditions) can diagnose and treat scalp psoriasis.
There are many ways to treat psoriasis hair loss. The root cause of this hair loss is psoriasis, so treatments that manage psoriasis symptoms should also help with hair loss.
Treatment options include topical medications (applied to the skin), oral medications (taken by mouth), and in-office treatments. Your doctor will prescribe the appropriate medication based on the severity of your symptoms.
If hair loss continues after treatment, talk to your healthcare provider about other treatment options or whether it could be caused by another medical condition.
Local remedies
Medications for scalp psoriasis that are applied directly to the skin may include:
- Topical corticosteroids: Corticosteroids treat inflammation. Your doctor may prescribe a topical corticosteroid medication that reduces scaling, redness, swelling, and itching. Long-term use of corticosteroids is not recommended, so your doctor may prescribe another treatment with corticosteroids to reduce possible side effects such as itching, rash, thinning of the skin and burning sensation.
- Medicated shampoos: Psoriasis shampoos containing clobetasol propionate (a steroid) are safe to use daily for up to four weeks, then once or twice a week to maintain results. If your symptoms don’t improve, your doctor may prescribe something else. Side effects may include burning, itching, redness and dry skin. Your healthcare provider may also recommend over-the-counter (OTC) shampoos made with coal tar, a thick black liquid derived from coal.
- Calcitrene (calcipotriene): This treatment involves applying a synthetic form of vitamin D directly to the scalp at night. It helps heal thicker patches of psoriasis and is sometimes prescribed as a combination drug containing calcipotriene and a corticosteroid. Possible side effects include itching, redness, burning, and worsening of psoriasis symptoms.
Oral medications
Oral medications your doctor may prescribe include:
- Soriatan (acitretin): This oral retinoid treats severe psoriasis by slowing fast-growing skin cells and reducing swelling and redness. Possible mild side effects include hair loss, chapped lips and increased sensitivity to light. Acitretin is not recommended for people who are pregnant, planning to become pregnant, or have liver disease, as it can cause potential birth defects, liver damage, and inflammation (hepatitis).
- Trekall (methotrexate): An overactive immune system leads to psoriasis, so your doctor may prescribe methotrexate, which suppresses an overactive immune system. Methotrexate is often prescribed for more severe cases of psoriasis, especially if other treatment options have not been effective. Side effects may include nausea and vomiting.
- biological drugs: Biological drugs are strong drugs obtained from plants or animals and their cells. They can be given orally or by injection. Biologics slow or stop inflammation and target the overactive part of the immune system that causes psoriasis. Possible side effects include upper respiratory infection, flu-like symptoms, urinary tract infections (UTIs), and headaches.
Treatments in the office
Some people may need in-office treatments if their scalp psoriasis does not improve with topical treatments or if they have thick scales on their scalp. In-office treatments include:
- Corticosteroid injections: A dermatologist injects a corticosteroid directly into the areas of scalp psoriasis. This method of treatment takes place over several sessions and is not effective for long-term use.
- Laser treatment: A dermatologist performs this treatment using an excimer laser, which delivers high-intensity ultraviolet B (UVB) light to areas affected by psoriasis. Excimer laser treatment can reduce inflammation and promote faster healing. It is most effective if performed 2-3 times a week for several weeks. Although usually painless, potential side effects can include pain and redness similar to a sunburn.
- Phototherapy (light therapy): This uses UVB radiation to treat psoriasis all over the body, including the scalp. During the treatment, you would either stand inside a light box, which simulates natural light, or the dermatologist will directly beam UVB light over your body. Phototherapy is a good option for children and people who are pregnant or have a compromised immune system. Possible side effects of this treatment include red or sensitive skin, stinging, burning, dark spots, itching and, in rare cases, blisters or burns.
Psoriasis is a chronic condition that can flare up even with treatment, but it is possible to reduce the risk of hair loss due to scalp psoriasis.
You can reduce your chances of psoriasis-related hair loss if you:
- Loosen and remove any flakes by gently brushing your hair
- Keep your nails short and avoid picking at the flakes with your fingers
- Use a medicated shampoo and alternate with a gentle, non-medicated shampoo every other wash; some medicated shampoos can dry out your hair, making it more likely to break
- Condition your hair after shampooing to prevent dry scalp and hair
- Air dry your hair; blow dryers can make dry scalp worse
- Patch test products for hair care and styling; if the product causes irritation or redness after a few hours, discontinue use and try another product
Scalp psoriasis is a chronic inflammatory skin condition that can cause hair loss. Other symptoms include dry scalp, red patches, itching and bleeding.
While psoriasis hair loss is usually temporary, it can sometimes cause scarring alopecia. It is important to see a doctor for scalp psoriasis treatment to manage symptoms and reduce hair loss.